Coughs that kill! Fear and global health
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This blog was produced as part of our seminar series: Governance and the power of fear.
When global health issues pop up in the news, it’s rarely celebrating the success of reducing infant mortality or smoking rates. Instead, we tend to hear about the problems—there’s a new disease spreading! Ebola has popped up in multiple countries! Within these reports, there is often an accompanying implicit (or explicit) message about fear. There’s a new disease spreading—and you could be next to get it. Ebola has popped up in multiple countries—and it could be coming to your country now.
When this happens, what we’re seeing is a process of securitization — framing an issue in such a way that it looks like an issue of national and international security. Traditionally, security issues have focused on military and national defence. Securitization takes non-military issues and attempts to reframe them as posing existential crises to a state’s continued existence.
Securitizing an issue like global health can have some benefits. It gets more attention, and policymakers may be more inclined to devote time and money to addressing the issue. There’s a strategic calculus that can go into securitization. It was not an accident that the United Nations Security Council first took up HIV/AIDS in 2000 by focusing on how the disease could undermine national institutions and weaken military forces.
For all the potential positives, though, the securitization of health comes with major downsides. It encourages an us-v-them mentality. We have to keep ourselves safe/healthy from them because they are dangerous/sick. This can distort where we focus our attention, and it can spread misinformation. Think back on the Ebola outbreak in West Africa. The disease sickened more than 28,000 people and killed more than 11,000, almost all of whom lived in Guinea, Liberia, and Sierra Leone—and nearly all of the cases outside these three countries could be directly traced back to people who had been in the region and the health care workers who treated them.
These facts did little to allay the way that public officials and the media talked about the outbreak. In a poll in October 2014, 52 percent of the respondents said that they were worried that there would be an Ebola outbreak in the US within the next year and 38 percent thought that they or their family members would get sick with Ebola. In a separate poll, Americans ranked Ebola as the third most important health issue for the country. Furthermore, Donald Trump sent a number of tweets (less than a year before he would announce his presidential run) that specifically targeted Ebola as a security threat — calling for restrictions on people traveling to the US and saying that health care workers who went on humanitarian missions to Ebola-infected regions “must suffer the consequences”.
Interestingly, calls for travel restrictions for people from Ebola-infected countries specifically went against the recommendations of the World Health Organization, which argued that travel restrictions would cause more harm than good. According to the International Health Regulations (to which all members of the World Health Organization are parties), states are not supposed to introduce trade and travel restrictions that go beyond WHO’s own recommendations.
In many ways, the reaction to Ebola is typical in that it focused on an infectious disease outbreak. These generate the sort of attention and accompanying worries that feed into an outbreak narrative — there’s an insidious infectious disease spreading, and we are powerless to stop it.
While the attention (positive and negative) paid to these international infectious disease outbreaks is, to some degree, understandable, the reality is that these moves distract us from addressing the main challenges to improving health around the world. By securitizing outbreaks like Ebola and SARS, we miss out on making the sorts of policy changes that would create better and more equitable health outcomes for all. Better health isn’t about heroically finding a new vaccine to prevent Ebola; it’s about the slow, patient application of proven techniques and building capacity to allow the health care system to respond to a wide range of concerns.
In particular, a focus on the fear generated by disease outbreaks causes three main problems. First, there’s the problem of the new. Policymakers and the media pay attention to disease outbreaks because there’s something unique, novel, and dangerous about them. The long-term threats to health may not generate the headlines, but they are the issues that cause the most illness and death. A focus on what’s new can distract us from the things that actually pose the biggest threat.
Second, there’s the shiny object problem. The fear-based health narrative encourages us to jump from crisis to crisis without thinking about what would be necessary over the long term to both prevent the crisis from recurring and to keep crises from emerging in the first place. Diarrheal diseases are the second leading cause of death in children under 5, and they are something that could be addressed through improved sanitation systems, but they get overlooked in the rush from crisis to crisis.
Third, there’s the resilience problem. Framing health as an issue of security and fear leads to a singular focus on a specific disease, not the broader health system—but having a resilient health care system that can provide front-line coverage for the majority of health issues that emerge and can spot potential new outbreaks before they spread too far is the most important element in a robust response to health concerns. Framing global health as an issue of fear works against building and supporting this sort of long-term structure.
We can’t stop people from getting sick and dying, but we can take positive steps toward ensuring people have healthy lives. A fear-based approach to global health works directly against this sort of approach.
Jeremy Youde is a Fellow in the Department of International Relations at the Coral Bell School of Asian and Pacific Affairs. His research focuses on questions of global health governance and global health politics.